Restoring a culture of compassion in a crisis

Periodically we hear about health care facilities where staff members appear to have lost their compassion for patients. Often these are facilities that care for the most vulnerable people. This was the case recently at Quincy Medical Center, where state inspectors found elderly patients with dementia, depression, and other psychiatric disorders who had been uncared for both physically and emotionally.

What causes a lack of compassion, and what can health care institutions do to restore the dignity and respect with which all patients should be treated, particularly after a crisis? Since we are not familiar with the details of what transpired at Quincy, the following are some general recommendations for all health care facilities facing a crisis in compassion.

A prerequisite to compassionate care is adequate staffing and resources. If caregivers are rushing from patient to patient, are inadequately trained, or lack the physical and medical resources to do their jobs, they are unlikely to be able to provide compassionate care to patients and families. The first step in a crisis is to make sure these resources are in place.

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Second is to immediately install new leadership that is committed to compassionate care. Health care leaders who embrace and model compassion play a critical role by communicating the benefits and value of treating patients and their families with dignity and respect, motivating others by their example and expectations, and marshaling needed resources. They also address the organizational factors that can contribute to compassion exhaustion. These include excessive workload, decreased professional autonomy, administrative demands that detract from direct patient care, lack of rewards, loss of a sense of community with colleagues, perceived unfairness and lack of respect, and conflict between organizational and individual values.

Third, caregivers need to be given the opportunity to drive the change that is needed, both in its development and implementation. Unless staff members are involved and invested from the beginning, true culture change is unlikely to occur.

People enter the health care profession because they want to be of service and to provide good care to patients and families. However, as time passes and caregivers witness emotional and physical suffering, pain, and trauma on a daily basis, their feelings of compassion may ebb. Caregivers may distance themselves from patients and become numb to patients’ pain and distress in order to protect themselves. This can be particularly true when they are caring for patients who are unable to communicate effectively or at all, and with whom they find it difficult to form relationships.

In these cases, there are a number of additional strategies that can help restore and sustain compassion. All staff need to be given the opportunity to express and process their feelings about the challenging situations they experience, ideally in a group discussion with their colleagues and moderated by a professional facilitator. These kinds of gatherings, held in the immediate aftermath of a crisis or traumatic event and then on a regular basis, can help resolve conflict, renew compassion, restore a sense of individual and collective purpose, foster community, and help people feel less isolated and alone. In addition, programs that teach caregivers how to take care of themselves emotionally and physically and to communicate more thoughtfully have been shown to equip them with the skills needed to avoid burnout, which can contribute to uncaring behavior.

It is also important to help institute mechanisms by which caregivers can come to know their patients as people. For staff in an advanced Alzheimer’s unit, for example, it is helpful to post photos and other information about the patient before he or she became ill. Making these images and information readily visible whenever a staff member enters the room helps caregivers see and understand the person behind the illness.

Information about patients can also be incorporated into their electronic health records so it is immediately available to all staff caring for that patient. Hospitalists at Norwood Hospital, for example, interview patients early in their hospitalizations to learn more about their backgrounds and preferences. They then record this information in what is known as the patient’s LifeBox, which is an area within the electronic medical record that stores this information for the use of other hospital staff members, for future hospitalizations, and for staff in other facilities to which the patient might be transferred.

Compassionate care used to be seen as the cherry on top – nice to have, but not essential. That is no longer the case. A growing body of evidence now shows that compassionate care is associated with better health outcomes, greater adherence to prevention and treatment recommendations, fewer medical errors and malpractice claims, lower costs, and higher patient satisfaction. Most importantly, it is the kind of care that health care professionals want to give and that all of us hope to receive when we are ill and vulnerable.